C. Puoti et al., CLINICAL, HISTOLOGICAL, AND VIROLOGICAL FEATURES OF HEPATITIS-C VIRUSCARRIERS WITH PERSISTENTLY NORMAL OR ABNORMAL ALANINE TRANSAMINASE LEVELS, Hepatology, 26(6), 1997, pp. 1393-1398
This study was aimed to evaluate demographic, clinical, histological,
and virological characteristics of 46 hepatitis C virus (HCV) carriers
with persistently normal alanine transaminase (ALT) levels and to com
pare the results with those obtained in a group of 52 HCV-RNA-positive
patients with elevated ALT levels. Subjects with normal ALT were more
often females (P < .001), were more likely to be asymptomatic (P < .0
01), and have a lower incidence of risk factors for HCV transmission (
P < .01). All patients with normal ALT had significant histological li
ver damage. The mean grading and staging did not differ between patien
ts with normal and those with raised ALT concentrations, Moderate to s
evere hepatitis was more frequently found among subjects with normal t
han with elevated ALT. HCV genotype 2a was far more common in subjects
with normal (43%) than with abnormal ALT levels (6%; P < .002), genot
ype 1b being more frequent in these latter (50% vs. 17%; P < .001). Pa
tients with normal ALT levels had similar serum HCV-RNA titers than su
bjects with raised ALT, Neither HCV genotype distribution nor viral lo
ad correlated with the severity of liver damage. We conclude that sign
ificant liver disease may occur irrespective of clinical symptoms, ALT
levels, HCV genotypes, and viral load.